Docket: IRS-2009-0008 

Request for Information for Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 

2008 

Comment On: IRS-2009-0008-0001 

Request for Information Regarding the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction 

Equity Act of 2008 

Document: IRS-2009-0008-0023 

Comment on FR Doc # E9-09629 

Submitter Information 

Name: Krystal S Angevine 

Address: 

Pekin, IN, 

Organization: Biofeedback Counseling Center 

Government Agency Type: Federal 

General Comment 

Comments regarding Regulatory Guidance USCG-2007-27022 

page 19157, II B specific areas 1 and 4 

I am writing this letter because current insurance non-coverage policies deny 

proven beneficial treatments from children. Therefore, it is my ethical 

responsibility to bring to your attention a disparity in treatment options. 

Currently, it is only those children with the financial means to pay privately 

that are able to receive the effective treatment that all should be able to receive. 

I am a clinical social worker who provides EEG biofeedback treatment to 

individuals with Attention Deficit Hyperactivity Disorder and Mood Disorders. 

EEG biofeedback is an empirically validated and widely recognized effective non 

medication treatment for ADHD, as well as other conditions. There are over 50 

studies evaluating the effectiveness of EEG biofeedback in the treatment of 

ADHD, Substance Use disorders and Autism. A recent review of this literature 

concluded “EEG biofeedback meets the American Academy of Child and Adolescent 

Psychiatry criteria for” Clinical Guidelines “for treatment of ADHD.” This 

means that EEG biofeedback meets the same criteria as to medication for treating 

ADHD, and that EEG biofeedback “should always be considered as an intervention 

for this disorder by the clinician”. This service has been denied by Georgia

PUBLIC SUBMISSION 

As of: May 28, 2009 

Tracking No. 809ad699 

Comments Due: May 28, 2009
Medicaid, Aetna, United Behavioral Health, Blue Cross, Cigna, and Amerigroup. 

This is limitation of an effective and validated treatment for a mental health 

problem. The reasons given by the insurance companies for this denial fell into 

two categories: 1) our company does not cover biofeedback for Mental Health 

problems or 2) there is not yet sufficient evidence for the efficacy of EEG 

biofeedback. As such, they are using evidence-based criteria that are far more 

restrictive for mental health services than the criteria which are used for 

medical/surgical services. There are many routine medical and surgical 

procedures which have far fewer controlled studies about their efficacy than 

does EEG biofeedback. These medical and surgical procedures are generally not 

limited because of concerns about how many controlled studies have been 

performed about them. 

We believe that the parity regulations, based on legal reviews of the parity 

statue should require that employers and plans pay for the same range and 

scope of services for Behavioral Treatments as they do for Med Surg benefits and 

that a plan cannot be more restrictive in their managed care criteria and 

reviews for MH and SA disorders when compared to Med Surg. Today plans are being 

more restrictive in how they review evidenced based Mental Health and Substance 

Abuse Treatments when compared to Med Surg treatments. This violates both the 

intent and letter of the parity statute and we hope that the regulations will 

clarify that this can't continue. 

Thank you for your consideration, 

Krystal Angevine, LCSW